Healthcare Provider Details

I. General information

NPI: 1760476808
Provider Name (Legal Business Name): CYNTHIA S HEIBEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013A S WELLS ST
EDNA TX
77957-4045
US

IV. Provider business mailing address

1013A S WELLS ST
EDNA TX
77957-4045
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-7820
  • Fax: 361-782-5627
Mailing address:
  • Phone: 361-782-7820
  • Fax: 361-782-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: